Avoiding an Epidemic

By Marissa Revilla

"On an ordinary day, of an ordinary month I found a small lump in my breast. I was worried. I had heard of breast cancer, but I was so young, so full of life, that I thought how could this happen to me?" said Claudia Santillana, of San Cristóbal de las Casas, Chiapas, who was diagnosed with breast cancer at age 29.

In Mexico, breast cancer rates are alarming. The disease is the number one killer of Mexican women ages 40-49, according to Mexico's Health Secretary. The cancer strikes Mexican women about a decade earlier than their U.S. American and European counterparts, reported a 2001 study conducted by the Surgery Department at the Mexican Institute of Social Security (IMSS by its Spanish initials.) In Mexico, 45.5 percent of breast cancer is detected in women under 50.

Chiapas ranks number 28 in breast cancer deaths in Mexico, according to data from the National Institute of Geography and Information (INEGI).

In Chiapas, the state with the lowest per-capita spending on health care, according to a 2006 report by Physicians Without Borders, doctors, and health advocates say the time to act is now, before the disease reaches epidemic proportions.

Breast cancer has several risk factors: family history, ingestion of hormones, nicotine use, poor glandular function, eating habits, and lifestyle, said Dr. Adriana Luna. Because Chiapas has a large indigenous population, between 28 and 32 percent, according to the state Secretary of Social Development, and indigenous women have more children and ingest fewer hormones and less nicotine than mestizas, breast cancer still is not a grave problem in the state, she said.

However, as more indigenous women come to the cities and urban lifestyles become increasingly hectic, more women are at risk for breast cancer. "The time to attend to this problem is right now, when it doesn't seem so grave. We have to work on self-care and prevention before more women die. We can't wait until the numbers are alarming," said Luna.

Early detection may have saved Adriana Aranda's life. She was 38 when diagnosed with breast cancer four years ago. Luckily, the cancer was caught early on, when Aranda's lump was still just a nodule of carcinogenic cells that had not yet spread. She underwent surgery, and has been cancer-free since.

"We must always be aware of our bodies and not be afraid of touching ourselves to make sure everything is okay," said Aranda, now 42. Aranda is living proof that "a timely detection can make the difference between life and death," she said.

Breast cancer can be detected in several ways. The most basic is a monthly breast self-exam. Clinical explorations are also available, and ultrasounds are recommended for women under 40. Women over 40 years old should have yearly mammograms.

In Chiapas, the governmental and private sectors are working to promote early detection and effective treatment. Eugenia Cristina Velasco Garcia, nurse responsible for the Women's Cancer Program, an initiative of Health Secretary of Chiapas, said her organization works to prevent and treat cancer in 18 municipalities throughout the state.

In 2006, the program screened between 300 and 700 women monthly at its health centers. Velasco Garcia said that that number is still too low.

Velasco Garcia's program conducts campaigns that offer free or low-cost mammograms and breast exams as well as information about breast cancer. But because the campaigns are infrequent, self-breast exams are still one of the most important ways for women to care for their health, she said.

But a 2001 study of health workers in a Veracruz hospital conducted by IMSS and the University of Veracruz, found that 58 percent of the participants do not practice breast exams or do them incorrectly.

In Chiapas, the Health Secretary has a budget specifically earmarked to cover the needs of low-income women who are diagnosed with breast cancer. But, when there is a lot of demand for services, and the money runs out, many women seek assistance with the Public Welfare, the IDH, or community groups that cover medical and transportation expenses so that women can continue their treatment uninterrupted.

In a sun-lit room, Claudia Santillana, now 33, feeds her two-month-old daughter Ana Paula. Four years after her breast cancer diagnosis, her dream of motherhood has come true.

Santillana was diagnosed in 2003 after finding a lump during a self-exam. She said it was hard to believe she had cancer. "A thousand questions hit me: Was I going to die? What about my family? My boyfriend? I was about to get married, about to graduate from college in a few months, and my life?" She said she felt like dying, "I thought the world had crushed me mercilessly."

The doctors removed a quarter of her breast, and upon examining the tumor found that it was more dangerous than they had originally thought. Her cancer had spread to her lymph glands and she underwent another operation to remove them.

Santillana, who had health insurance, underwent chemotherapy and radiotherapy at the same time; the results were brutal. When she began to lose her hair it was a shock. "I, who was always so vain, saw myself bald in the mirror and thought, 'If only this was just about losing your hair. But if you have your life, you've won,'" she said.

This January, Santillana underwent a series of tests that confirmed she is still healthy.